The Bestest VBAC of All

So I got an epidural for my VBAC.  Get over it.”  What a great title!  You know exactly what kind of story you’re going to read and can even take a guess at the spectrum of responses to such a post.

I think this is an important post to read.  A VBAC doesn’t have to be a fully unmedicated waterbirth at home to be a ‘success.’  Yet, we run the risk of presenting a set of demands on VBAC mamas, and for many if not most this might be obstructive.

My sense of this woman’s story is that she got the epidural knowing what risks and benefits are involved.  If not, then yeah, maybe she got lucky.  My sense of other women’s stories who have had epidurals, is that even though in most women, the risks may outweigh the benefits . . . some women just don’t dilate or labor well without them.  Perhaps we can hindsight quarterback their birth preparation process, but I think that’s a fruitless discussion.

I agree with Andrea’s point that fighting about the best way to VBAC isn’t constructive.  Ideally, we wouldn’t even need to address the “best way to VBAC” if we had a medically-appropriate cesarean rate in this country.  And if “normal birth” (and I do mean natural) has a high degree of variability, so much so that we insist women be left to labor in peace without clock pressure, then we must be willing to accept variability in the way women pursue their VBACs.

Most of us, I would assume, who consider ourselves to be VBACtivists, are working so hard to re-educate women about patient autonomy, patient choice, informed consent, and participating in health care choices, that we start from the position that a woman who requests an intervention such as an epidural during a VBAC labor doesn’t know the risks.  And this is probably how the squabbles begin.

Further, plenty of “die hard” VBAC gals make “natural choices” that I find potentially risky.  I’m pretty specifically talking about the use of EPO for home induction and tonics such as 5w or PN6.  And some women say NO to induction but YES to augmentation.  And some women agree to AROM (having their waters broken).  Some women have their membranes stripped.  And I get it . . . because as soon as you get to 40 weeks, you’re treated as a ticking time bomb.

What will I do this time?  Only time will tell.  But you bet your butt that if I get exhausted laboring at home but think an epidural will help me regain the strength to birth this child vaginally, we’ll hop in the car and accept the the bad with the good.

Birth Witness: My Friend’s Amazing Birth

My girlfriend gave me an extraordinary gift last week.  She’s had a complicated pregnancy due to polyhydramnios, and no one thought she’d actually make it to term.  She did!  And I witnessed it!

She and her doctor decided that induction was appropriate.  I certainly wasn’t going to pass judgment on that given all she had been through.  When she went in for induction, her fundal measurement was 48 weeks.  Bless her heart.  Of course I worried about her and hated that I had to be at work while she was being “treated.”  She was induced early in the morning and had her water broken around 2:30pm in the afternoon.  I was concerned about that decision since we all knew the baby wasn’t engaged at all.  That could have caused cord compression and/or prolapse which would have been a quite route to a cesarean. 

Pitocin was of course used to increase her contractions, and at some point, the pain became unmanageable, so she was given an epidural.  I think it was a pretty good epi, because she still had a lot of sensation in her legs and pelvis.

I arrived around 7:30pm to keep her company.  She was quite nauseated, poor thing, because she does not tolerate medicine well.  She had been checked at 7pm and was only 4cm dilated.  I don’t think anyone was very happy with that progress.  However, her nurse was very supportive of my friend’s desire to avoid the cesarean, but of course, since my friend couldn’t really move, the way she was supporting this goal was through medical management – increasing pitocin, increasing the epidural to cope with the pain, flipping my friend side to side (when the baby’s heartrate ‘allowed’). 

We were all very pleasantly surprised when she was about 6 or 6-1/2 by 8:30pm or so.  She was becoming more uncomfortable, and things started to progress much more quickly.  Her hubby called her mom and told her to hurry on her way.

Soon after, my friend started to feel pushy.  It was pretty exciting.  The nurse delayed calling the doctor because she assumed it would still be a while.  (I guess you don’t call the doctor until you’re really sure . . . Her doc wasn’t on call but was still planning on delivering the baby.  Good on him!)

Anyway, lo and behold she started making progress rather quickly, and I swear it was no time before you could see the baby’s head.  It was amazing for me as an observer since when I arrived, she was feeling pretty certain that the baby wasn’t making adequate progress.  And it’s not like anything active other than medical management was being done for her to encourage the baby to engage. 

At some point the nurse told her to stop pushing.  Yeah right.  As soon as the nurse left to call the doc, I told her to go ahead and push.  There were plenty of people around there who can catch your baby.  So she went on about her business.  I was surprised that she was purple pushing (pushing to counts of 10), but it seemed like she wanted someone to count, so that’s what was done.

The doctor arrived and told her to slow down.  I didn’t get how wise that was at that particular moment.  But he told her, and I’ll remember this, “let it build, and then push when you can’t resist.”  All in all, I think she pushed for about 45 minutes, and she only needed 2 stitches.  Because he was encouraging her to control her pushing, she didn’t tear badly.

The baby emerged – first the head, of course.  I left my position by my friend’s head, grabbed the family’s camera, and started taking pictures.  I don’t know if she’ll appreciate having pictures of a baby sicking out of her vagina, but man, it was the most beautiful thing I had ever seen in my life.  It seemed like the shoulders were a bit sticky, but they freed eventually, and the rest of the baby slid out easily.  A beautiful big cord hung from my friend’s body.  The baby had a huge conehead – the head really had to mould to get through my friend’s pelvis.

The baby took a while to come around.  I was distressed that they weren’t bringing the baby over to my friend very quickly.  It seemed like they were doing a LOT of unnecessary stuff.  My friend kept asking for him.  I’m not sure she even got to see him for 15 minutes or so.  Ick.

Stage 3 of labor was over-managed, in my opinion.  The OB applied traction to the cord.  An enormous placenta came out.  It was impressive!!  The OB then began externally massaging my friend’s uterus.  I don’t recall what else was done to/for her.  I was more focused on her emotional state and the baby. 

We were all amazed to discover that the baby was 9lbs and 15.4 oz!  No wonder the baby’s head was so pointy.  I am so glad the doctor encouraged my friend to adjust her pushing strategy.  In the end she only needed 2 stitches!  Amazing.  With the cone, the baby measured 24 inches long.  He was so beautiful.

Mom and baby were finally united, and he was latching on within minutes.  I left soon after to give the family some private time to bond.  I had a hard time going to sleep I was so “high.”  I figured I’d be an exhausted puddle of a woman the next day, but I was still “high” from her birth.

I can’t adequately verbalize how much it meant to me to be there as a witness and as a support person.  I don’t know that she really needed me there, but she knew I needed to be there.  As I write this, I am tearing up.  I’ve never seen or experienced a vaginal birth.  It was such a marvelous thing for me.  And it’s helping me “see” my own upcoming birth.

I’ve studied birth.  I’ve watched movies.  I’ve watch natural birth videos on YouTube.  But there’s nothing like being there in person with a laboring mom.  There’s no substitute for seeing a new person emerge from someone’s body.  And now I am bonded to birth – this experience can’t be taken away from me no matter what happens in the next few months.

The Few Minutes I Remember

I was just reading A Day They’ll Never Forget from the Giving Birth with Confidence blog.  It’s wonderful to read stories like those – truly beautiful, uneventful (in a good way), unencumbered births.  I can’t relate to them at all, but I still have hope.

In stark contrast to these four womens, my children have been cut out of me.  I don’t remember all of the details of their births, and I never will.  Is it because of the anesthesia?  Is it because a cesarean section is a traumatic experience for the body . . . and the mind?  So many people just don’t seem to understand that it should be fairly uncommon for a woman to need to have major abdominal surgery as a result of trying to birth her babies.

My water broke just short of midnight one night in August 2009.  I was trying to get comfortable enough to sleep, but Baby A had been making that quite difficult for some time.  This night was no different.  I piled pillows up and tried to lie down in a modified child’s pose.  No sooner had I settled, Baby A started moving vigorously and with a swift kick, obliterated her amniotic sac.  I cried out – “They’re going to cut me open.”

I had hoped that Baby A would turn back from breech before they were born, but breech presentation was confirmed at the hospital.  I was prepped for surgery.  This is the end of what I remember clearly.

Today’s Notable Reads

Today is a banner day on my Facebook news feed.  Here are some things that piqued my interest.

  • Owen Wilson and his girlfriend welcomed their baby into the world at home!  I’m not providing a link – I figure you can go to your favorite celeb site if you’re curious.  ;)
  • Did you know that nearly 100% of us parents use car seats incorrectly.  Here’s a 5-minute video featuring “The Car Seat Lady.”
  • I haven’t read this yet, but check out this New Yorker article regarding the decline effect and the scientific method.
  • Homebirth: A Midwife Mutiny is a great blog.  I first read Risk, homebirth, VBAC and am now on to her take on a BBC News article about “womb tearing.”  Next, I think I’ll read Blaming Women, because HELLO it happens all the stinkin’ time.
  • I’m also curious to read a new-to-me blog today, particularly the article on “No, Actually, You Did Not Turn Out Ok.”  We’ll see – I’m a fairly mainstream mama, so I don’t know how I’ll respond knowing that this is one of the blogger’s perspectives: “Where I Post . . . And Kick Your Lily White Arse For Making Your Baby Cry-It-Out.”  We ended up doing CIO with our oldest.  Is she ok – not completely.  Is it because of CIO – not necessarily.  Are we ok – no completely.  Is it because of CIO – not exactly.  But hey, let’s blame ourselves (see blaming women above) and each other (a favorite past-time for some on Facebook) for our kids becoming assholes or freaks as if THEY have nothing to do with it.
  • DEEP BREATH
  • My favorite spot on the internet for sound pregnancy & birth related advice – Childbirth Connection

We already feel inadequate

I watched Orgasmic Birth last night on Amazon.  When I told my husband what I was watching, he gave me a look like “oh no, you’re going to be one of those women this time, huh?”  I told him that despite the title, the movie was supposed to be good, and for the most part it was.

If you go to the OG website, you’ll see that they define the word orgasmic differently than you would expect: “Intense or unrestrained excitement or a similar point of intensity or emotional excitement.”  I’d agree that all of the normal physiologic births shown on the video demonstrated intensity.  It’s important to read the definition above with the word “or” in mind.  A woman does not have to achieve orgasm during labor/birth to have an orgasmic birth.

I found it interesting that one of the interviewed NCB experts suggested that we don’t share our birth stories because we don’t want to make other women feel inadequate.  Perhaps a woman who consents to an epidural in a hospital setting will feel inadequate, I don’t know.  But, a woman who has undergone a cesarean after trying to labor will almost always feel inadequate in some way.  (I know there are always women out there who will say different.)  Let me explain.

A woman is told that babies come out of vaginas, and that most of the time that is possible.  Women may enter into the last stages of pregnancy knowing that they want an epidural or to be induced, but they still expect that in most cases, the baby is going to come out normally.  However, most hospital birthers are not given the right kind of support to achieve a natural physiologic birth or normal birth.  Inductions are fairly normal.  Augmentations are fairly normal.  Epidurals are extremely common.  As one expert pointed out on the movie, when most (like 90%) laboring women receive an epidural, and you don’t, you take the staff out of its comfort zone.

So after these interventions and more (constant monitoring, restricted movement in labor, etc.), women are still expected somehow to birth vaginally.  And a third of us are sectioned – or more, depending on the location.  Our bodies failed us, we are lead to believe.  “Thank God I was in the hospital or my baby and I would have been in big trouble.”  Our inadequacies are magnified by the overwhelming successes of the medical machine.

Women who have had cesareans are defensive.  “My cesarean was necessary” is a common belief.  But to suggest that women don’t share their birth stories because they don’t want to make a cesarean mother feel inadequate is not understanding the situation.  We already feel inadequate.

I am 1 of 3 women sectioned in childbirth.

I am one of numerous women told that her body wasn’t capable of birthing her baby.

I am 3 of 4 women sectioned in Montana for twins.

I am nearly 100% of women in my community told they cannot have a VBAC in the hospital after multiple scars.

I am nearly 100% of women told to be thankful that they have a healthy baby after a cesarean section.

Share your birth stories in a supportive, instructive, and hopeful manner.  Give cesarean mamas hope that next time can be different, if she chooses.  And she has to choose; you can’t choose for her.  I myself am preparing for a transformational experience this summer.  I can’t get there unless I embrace stories of uninhibited natural physiologic birth.

Birth Story: Successful Birth Center VBAC

I am thrilled to offer this unedited birth story on my blog.  Many thanks to the fearless mama for sharing it with me and anyone else reading.  I am thankful that my community, and in particular this CNM, is making strides to reacquaint themselves with natural, normal birth. ~ labortrials

History: 2 1/2 years ago I had a scheduled c-section with Naomi. I had something called “placenta previa,” which is a “chance” thing that can happen in a pregnancy where the placenta covers the cervix, thus making labor dangerous and a normal vaginal delivery impossible. Because placentas move during pregnancy as the uterus grows, the doctors weren’t sure until we moved back to the U.S. that I had placenta previa. I was put on bed rest to prevent labor at 34 weeks and then advised to plan our c-section for the beginning of my 37th week. Naomi’s birth wasn’t traumatic for me, but I longed to be able to experience a “normal” birth…or at least be given the chance! Even though my c-section was absolutely necessary, I soon learned that many c-sections are not truly necessary, and that many doctors nowadays are absolutely mortified to attend to vaginal births after caesarians (VBACs), due mostly to fear of lawsuits if something goes wrong (the big one being a uterine rupture at the c-section scar). As soon as I found out I was pregnant with Elijah, I began reading everything I could about VBACs so I could do my best to prepare my body for birth and minimize any risk (which, by the way, is only .5% for a uterine rupture – much less than many other “normal” complications women have in first births!). In my research, I was shocked how unnecessary many routine interventions are done in hospitals and how this might affect any woman’s labor. I was determined to not have to go to the hospital, where I would automatically tethered to an I.V. and continuous fetal monitor. So I went the other way and found a CNM (certified nurse midwife) who had just opened a birth center in town and was willing to let me experience labor. If anything were to go wrong, the birth center is only a 5 minute (or less) drive to the hospital, so we felt very secure in our decision and Jeanne’s (my midwife, pronounced “Jean-ie) experience and expertise.

My Birth Story

I was putting Naomi to bed at 7:30 on Saturday night May 8th when all of a sudden I felt a little “pop” inside me. Pregnancy brings about all kinds of weird feelings, so I wasn’t sure what this was at first, but then when it felt like I had just peed my pants, I had an idea.

I freaked out. My due date was May 21st, so this was 13 days before my due date. Of course I was saying I was “ready” for this baby to be due…but was I really READY to do it now?! I checked the fluid – clear. Good sign. It kept coming. I called Jon (who was getting off work at 8). I called my midwife to find out if the fluid could be anything else at all. Nope. My water had broken 13 days before my due date and I had 24 hours to safely have my baby (more than that after the bag of water breaks and you have to start worrying about infection). Wow. This is crazy.

I had not felt a single contraction until this point in my pregnancy. Here we go!

I was told I could start contractions right away or not until much later, even Sunday afternoon – since we didn’t know what to expect, we called my mother-in-law and asked her to take Naomi for the night, just in case. She came by, her and two of my sisters-in-law prayed for me and baby before leaving (I was still in a bit of disbelief at this point), and they took Naomi to sleep at their house.

Jon and I started to watch a movie and relax and rest. I had a meal so I could have some energy if labor started. Light contractions started at 9:00, about 5 minutes apart. I went to bed at 9:30 so we could try and get some rest. Jon slept. I tried but didn’t do a very good job. Contractions stayed at 5 minutes apart but gradually got stronger and stronger. We called our doula Ali (whom we had only met with once before! Our next meeting was to be the following monday!) and midwife Jeanne around 11:45 after they moved to 4 minutes apart and I knew I was going to have to come in within hours. Jeanne told me to call again when contractions became 2-3 minutes apart. Okay. Around 3 A.M. I asked Jon to call Ali over and we called Jeanne. Jeanne told us to meet her at the Birth Center at 3:45.

Ali arrived at our house around 3:15 and immediately started helping Jon and I through my contractions. By this time they had become strong enough for me to need to focus intently through each one. I had started moaning through them to help with  the pain, too. I had read in several books that this was a good thing to do during labor because of the relaxing, opening  effect that open, low tones have on the body. What I later found interesting was that I didn’t really think about doing this as I was doing it…it just seemed like something that was natural and that I should do! And I definitely believe it helped.

We left for the birth center around 3:45. We live a mile away from this so I was VERY grateful not to have to be in a car too long. I had one contraction in the car and did not find it very fun.  Anyway, we got settled in to the room in the Birth Center room. I was so worried that I would only be at 5 cm dilated or another low number and have quite a way to go. Jeanne checked me. 7 cm. dilated! YES! We’re getting close and I’m almost to transition! Okay, I can do this!

I got in the jacuzzi tub next and this felt SO GOOD! With Ali on one side and Jon behind me, I spent an hour in there, where things really became intense. Jeanne had been quietly preparing this whole time, candles were lit, the room was so calm and peaceful. Jeanne also checked the baby’s heart rate every 10 or 15 minutes to make sure baby was doing well (a sudden drop could mean a uterine rupture or other complication). Heart rate was perfect every time. Awesome. I had brought a bag of snacks and drinks to eat/sip during labor and then, ironically, all I wanted was ice cubes throughout the hardest part of this labor! They were heaven in my mouth – truly. After about an hour, Ali suggested I get out for a little bit to change positions again. At the same time I felt it was a good idea, I went through another contraction and OH! TIME TO PUSH! I had spent my entire transition (dilating from 8-10 cm) in the tub. Perfect! We slowly made it over to the bed, Jeanne checked me to confirm we were there (at least I think she did…things kind of got fuzzy around now). Okay, it’s go time.

Pushing was hard, and since this was my first birth, it was definitely 2 steps forward one step back. I was holding on to Ali and Jon’s hands really hard. Pushing was the most intuitive thing I have probably ever experienced. My body was working, doing what it needed to do, and it didn’t seem as if there was any other option than to just let it push. It wasn’t my decision – it was simply time to push! No stopping this train!

I’m not exactly sure how long I pushed – 45 minutes to an hour, possibly. I had no concept of time at this point. At times Jenny the nurse would put a mirror down so we could see Elijah’s head as he slowly emerged. I didn’t want to look at first but it ended up really helping me focus. My baby was coming, and I was ready to meet him! Elijah David King was born at 6:29 in the morning. Jeanne immediately put him on my chest; he started crying and it was the most amazing feeling in the world. We had done it! I had had no drugs whatsoever, felt every sensation, and was constantly in the moment, aware of my baby and the sheer power of my body doing what God intended it to do. Elijah was messy, beautiful and alert. Just amazing! I can’t describe it. Nothing had gone wrong and I feel so extremely blessed. I got my VBAC! I trusted my body and our first son was born without complication with him or me (or Jonathan’s hand…poor guy, I was gripping so hard there at the end).

I pushed out the placenta (piece of cake!) then Jeanne spent some time stitching me up (I had a 2nd degree tear…not too bad. Still a little sore as I write this, though). Jonathan, Elijah, and I laid there in the bed for quite a while, bonding and admiring each other (me still in a little bit of disbelief that I had pushed that head out of me…so amazing what the human body can do!). At least 30 minutes later, we were ready for them to clean up Elijah, so Jenny took him and weighed him (8 lbs even!) and cleaned him off and gave him back to us. We tried nursing and he immediately latched on – I had so many problems nursing Naomi so this was such a relief. I got some ibuprofen to help with my sore bottom and the strong uterine contractions (still having those a few days later as it takes 2 weeks for the uterus to return to normal size). My mother-in-law, Naomi, and a few of my sisters-in-law came and visited us a little later, bringing blueberry pancakes, eggs, bacon, and fruit. It was wonderful. Jon took a nap (figures…wimp!) but I couldn’t sleep yet. Jonathan and Ali were amazing – they supported me and cheered me on through the entire labor, moaning with me, breathing with me, telling me I was doing a good job, etc. It seems so simple, but helps so incredibly much. Who knows how much longer my labor might have been without the wonderful positive support!

We left the Birth Center around 11:45 in the morning to go home, only five hours after Elijah was born. I walked to my car, feeling sore but wonderful, still on a natural high from giving birth naturally! Elijah’s birth was the very first VBAC at this birth center!

Now, two days later, I’m still getting reacquainted with nursing, still a little sore and tired, but feeling great. Elijah’s doing so well, too, and we are completely in love with our new baby. Naomi seems to be taking well to baby brother too! She likes to come kiss him and gets concerned when he cries or she thinks he doesn’t have enough blankets. I love our little family and we feel so blessed to welcome our new, incredible miracle.